Provider Demographics
NPI:1861781908
Name:CHANDLER, JOHNNY BRENT
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:BRENT
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:70 WHITLOCK PL SW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3155
Mailing Address - Country:US
Mailing Address - Phone:770-425-6770
Mailing Address - Fax:770-425-6770
Practice Address - Street 1:70 WHITLOCK PL SW
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3155
Practice Address - Country:US
Practice Address - Phone:770-425-6770
Practice Address - Fax:770-425-6770
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies